Analysis of factors influencing the efficacy of subcutaneous immunotherapy for children with mite-driven allergic asthma
Objective To analyze the factors influencing the efficacy of subcutaneous immunotherapy(SCIT)for children with mite-driven allergic asthma.Methods The clinical data of 42 children with mite-driven allergic asthma who received standardized SCIT for more than 1 year in the pediatric respiratory specialist clinic of Affiliated Hospital of Yangzhou University from July 2018 to May 2022 were retrospectively analyzed.According to the daily dose of inhaled corticosteroids(ICS)12 months after treatment,they were divided into a ICS discontinuation group[fluticasone propionate(FP)=0 μg]and a ICS maintenance group(FP＞0 μg).In the ICS discontinuation group,there were 14 boys and 1 girl,aged(8.7±2.9)years.In the ICS maintenance group,there were 20 girls and 7 girls,aged(9.7±2.2)years.The changes of ICS daily dose and therapeutic effect before and after standardized SCIT were compared between the two groups at the beginning of treatment and 6 months and 12 months after treatment,and the related factors affecting the efficacy of SCIT were discussed.Independent sample t test,Z test,x2 test,and multiple logistic regression analysis were used.Results After 12 months of treatment,15(35.7％)of the 42 children were able to withdraw from ICS use(ICS discontinuation group)and the remaining 27(64.3％)children needed only a low dose of FP to maintain the asthma symptom control(ICS maintenance group).Six and 12 months after treatment,the daily doses of FP in the ICS discontinuation group and the ICS maintenance group decreased compared with those at the initial treatment(all P＜0.05),and there were statistically significant differences between the ICS discontinuation group and the ICS maintenance group at the same treatment time point[50(0,100)μg vs.100(75,100)μg,0(0,0)μg vs.50(50,100)μg](Z=-3.54 and-5.51,both P＜0.001).The proportions of overweight,allergic rhinitis,living with smoking members,and multiple allergies in the ICS maintenance group were higher than those in the ICS discontinuation group(all P＜0.05).Logistic regression analysis showed that living with smoking members(OR=6.179,95％CI 1.029-37.118,P=0.047)and multiple allergies(OR=7.772,95％CI 1.077-56.085,P=0.042)were independent risk factors for non-complete withdrawal of ICS after 12 months of treatment.Conclusions SCIT can significantly reduce the daily dose of glucocorticoids in children with allergic asthma while ensuring the control of asthma symptoms.Children living with smoking members and children with multiple allergies are at higher risk of continuing glucocorticoids.
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